Type One Diabetes And Conceiving

I don't quite know how I am going to start this blog post without saying, thank you Jesus. I'm about to go through a nine month journey with you (before even becoming pregnant) that has truly been one of the hardest time periods of my life. I think what made this time so challenging for me, mentally and emotionally, has been the unknown. The question "why?" The classic "is this my fault?" But before I get into why the last nine months were so challenging, I need to give you some context as to the years leading up to wanting a baby.

Three years ago

Three years ago, I decided to get a pump. This was something I felt strongly against my entire diabetic life. I was on MDI for about 18 years before deciding to make the switch. And MDI worked for me.... until it didn't. The true reasons I made the change was a) to get my numbers in a better range so pregnancy changes would be easier and b) address overnight dom phenomenon that was ruining my eyes. My numbers have always been okay during the day. Normally I'd wake up with outrageously high numbers (200, sometimes 300) and give myself a giant bolus. I'd then workout. This would bring me down quickly, normally to a low number. I'd have a quick rice cake and move on with my day where my numbers were normally between 100-200. Not ideal, but if they were high I simply made no changes until my next meal because I was either working or didn't have my shot on the fitness floor. And until you live a single day with type one diabetes, would I like you to tell me this is laziess. This isn't laziness, this is denial. Denial that diabetes must take over my life to actually be controlled. Another reason a pump would be so much easier to manage my numbers all the time was the mere fact I can't leave my pump in the locker room quite like I could an injection. The pump would be attached to my body 24/7, which isn't ideal for someone who lived so detached from diabetes.

I am on the Omnipod 5 and Dexcom G6

Anyways, I wasn't worried about this throughout my entire twenties. This was just how life was and diabetes simply took the back burner. That was until it started to affect my eyes. I immedietaly got a CGM which helped a lot. At least I could see my numbers all the time, and was able to make adjustments a little quicker. However the CGM truly just sparked more anxiety, because taking a shot isn't always ideal in certain settings nor is it easy to do as a personal trainer working with clients. So if I'd see my numbers rise, I'd still have a hard time bolusing insulin. It's just now, I knew about it.

As I made my first appointment for retinopathy injections, I decided I might as well make my first pump appointment. I decided to get the Omnipod, because it was tubeless. In June of 2023, my life was changed with this device. I'd like to say for the better, but also for the worse. For about a year, I dealt with constant lows while running, understanding the in's and out's of insulin on board, knowing that my pump won't really work well a few hours after inserting it, and the dreaded weight gain. I remember crying to my husbad one night laying down before bed. I literally told him my life was about to change forever. I am most likely going to look different with weight gain, I will never not be hooked up to multiple machines, and he now has to learn how to take care of me in case something goes wrong. A pump has more risks than MDI does in my opinion, and I never fully gave Mike the education because I never thought I'd have to. The pump brought along many scary moments like countless lows on runs (where I am miles from home), horrible days of insulin insensitivity because of "bad sites", and a terrible trip to the emergency room with DKA. That was the worst I think I had ever felt, and I couldnt do anything for myself. I had to rely on my husband to keep me alive as we found the proper help. Yes the pump has brought many scary situations, but it also landed me a 6.4 A1C; where as I thought I'd never get below 7....ever.

So what does the pump have to do with pregnancy? The pump was going to make preganncy easier because while pregnant, diabetics must stay in a tight range. This range is normally between 65-140. Obviously as a diabetic, that is incredibly challenging. Bloodsugar doesn't just rise and fall with food, but with stress, hormones, sleep, not eating enough, exercise, sitting, standing... bloodsugar levels pretty much have a mind of its' own when you don't produce any insulin. YAY for me for having such an incredibly high responsibility for this poor baby. The reason for keeping your numbers so tight is due to complications for the baby; if your numbers run high (which again... is over 140. WTF!) your baby could be at risk for enlarged organs and heart. If you run high or low, stillbirths and miscarrigaes are common. It's incredibly scary when you think about it; all the factors that come along with pregnancy plus your own responsibolty of keeping this child alive and healthy by something that is out of your control. So this pump was in my future, and I knew it if I wanted to have a child.

Trying to conceive

When we started trying to conceive, I had the pump for a little over two years. We purposefully wanted to start trying after a trip to Europe so we kept the whole fall of 2024 open. I signed up for zero half marathons and I made all the appointments to my OB and even got a new endocrinologist who speciailizes with pregnant T1D's. You may think I have this all figured out, right? Well, I knew this was going to be a journey because I hadn't had a period since 2018. And even worse, those periods were inflicted by birth control... which I started becuase of, you got it, irregular periods. The start of my irregular periods stems all the way back to eighth grade. I had maybe two periods before just not starting again that whole year. Freshman year, I developed an eating disorder that lasted most of high school so of course I wasn't going to start my period being underweight. When I went to college, I started birth control merely because my doctor said it'd be healthier to have a synthetic period than not having one at all. I believed him, becasue I am not a doctor and I was 18. Fast forward to being about 24, I began learning about the pill, female hormones, and health. I realize this is everyones personal choice for taking the pill; but I realized I made the choice being so uninformed and that my new choice was to stop taking it. I'm not going to dive into the science of why; you can do your research. But I believe that amount of time my body was told to "hault" making hormones because the pill would do it for me, fucked my body up.

Introducing alllllll the medications There was some light at the end of this tunnel, though. God magically waved his wand and I started my period authentically three times in 2024. I was amazed and so happy! But by the time we were ready to start trying for kids, I had no way of knowing if I ovulated. So the first step was to take progresterone medication and start my period, then taking a medication to stimulate ovulation. I took letrozole, because my doctor said it had the smallest side effects. By taking progesterone for ten days, the "withdrawl" would stimulate a period, similar to how normal hormones work in your body around your cycle. When I started my period, I would take letrozole for days 3-7, then begin trying on days 10-20. On day 21, I was to get my blood drawn and test my progesterone levels. The level would indicate I ovulated if the value was over 3.5. When I tell you how many times we did this and continued to increase the letrozole amount becasue I didn't ovulate.. you'd be sick. As much as my husband loved days 10-20, I was ridden with anxiety. We'd either a) ovulate and get pregnant, b) ovulate and not get pregnant or c) not ovulate and not get pregnant. Basically from October until March, we tried, wait, and get a negative result.

Mental health & self worth

I have to throw a wrench into this story and tell you that during this time, I was having a lot of questionable knee pain. Starting in October, I was unable to run, squat, lunge, basically do anything with a lot of knee flexion. For the first month, it was fine. I've been injured before, I know the drill. Time + therpy= recovery. I went through all the physical therapy exercises I knew every single day. I walked on the treadmill instead of cross training. But nothing, and I mean nothing, made it feel better. This time frame lined up perfectly with our failed conception attempts. For months, I was unable to do the sport I love, really workout at all, and I was failing at creating a child. My self worth and my purpose felt so questioned. This may sound little to you all, or maybe even an invited excuse if you hate exercising. But my entire identity is being a runner and lifting weights. And for some strange and unknown reason, both of these sports were taken from me due to this knee issue. After about two months of not getting better, I got an MRI done to rule out arthritis or any torn ligaments. And voila, nothing. I got zero answers from the MRI besides the "swelling" I already knew I had. If you're a runner, and youve been injured before, you know that you want nothing more than to race during your time of injury. The want to run so freely was at an ultimate high. I felt so lost with my time and my ability to even be a good trainer. Throughout January and February, my healing process began and I slowly added in miles. Still as I write this blog post, I'm only about four miles deep into running and I still havent back squatted with weight yet. I know I'm healing, but God has made this injury a long one. *As I am posting this, I am pretty much 98% healed. I'm squatting and running again, ut even this took 8 months to heal!

My mental health was really, really unwell. I felt like I was losing fitness by the day, I spent all my time questioning if I was eating enough or resting enough or taking the right supplements to convieve, and I continuously got negative outcomes. My heart ached every night and I'd cry to my husband daily that I didnt know who I even was or what I was even meant to do on this earth without my passion (running /lifting). During this time of feeling so alone, we really leaned in on God. We went to church every single sunday, we prayed every single night (for concieving and healing) and we talked to others about God daily. Our faith grew sttronger as our hearts grew sadder and lonlier. Isn't that strange? When you feel so alone, there's such a strange comfort in praying and believing in something. And our something is Jesus.

My first positive ovulation

The final trail to ovulate was at the end of February. My OB called in for the highest doesage of Letrozole allowed; and we were to try again. The letrozole and progesterone of course made me feel hormonal, bloated, gain 2-3 pounds of water retention and really just made me feel off. I hated taking it but it was so worth the small side effects if it landed me a positive pregnancy. I remember the day I got my blood drawn... I was so nervous to check MyChart for the results. I had had numbers like 0, .21, 2.3 as our failed attempts of ovulation (your progesterone must be above a 3.5). So with the max doseage, if I didn't ovulate, I'd have to go see a reproductive specialist meaning IVF. I am still open to IVF if that ever becomes the case, but for this trial... my progesterone level was a 26!!!! I was so relieved to see that number pop up on MyChart. Even if I didn't get pregnant this round, I felt like something I was working so hard on actually worked.

From left to right: three results of past progesterone levels, progesterone level indicating I ovulated, my OB's excitment!

My Positive Pregnancy

Of course after the positive ovulation test, I wanted to check if I was pregnant a few days after that. Obviously, this was too early to see a faint line and it came back negative. I tried to not think of anything but try again in a week. And that I did, to see a fine faint double line. I could not believe my eyes and truly thought I was seeing things. I had an idea of how I wanted to tell my husband, but if this idea were to actually work, I had to keep it a secreat for five whole days. Each day leading up to telling Mike, I tested a more positive pregnancy test which made me even more excited that it was real. I dated each test so I could see the progression of the line. The entire week, I slowly stopped drinking Nitro cold brews, eating deli meat, eating steak with any pink inside, and stepping on my body-fat scan scale (electric impedence). I made all these small changes without Mikes awareness.

Double lines <3

When I got to the day of telling him, I talked him into going to True Food Kitchen at Easton. We had recently walked past it and mentioned eating there soon. We had ate there the day we signed for our home, so it's a special spot for us. However, I wanted to park on the otherside of the town center because right when you walk into the mall, there is a photo booth. My husband and I have frequented photo booths throughout our relationship; a tradition we started so long ago and have kept ahold of the photo strips all this time. This time, I'd get him inside the photo booth, take the first pic, and as the second one cued, I'd pull out the positive pregnancy test.

When I say that my plan when EXACTLY as I had imagined... it did. And it was so incredible. He could not believe what he was seeing and the photos captured it all. I am so grateful to be able to remember this special moment forever.

Photo booth telling my husband I am pregnant!

My current state of mind and advice for those TTC

As I sit here writing this, I am about seven weeks along. I haven't had my ultra sound yet, but it's coming up in a few days. I want to tell you, that my mental health has completely taken a 180. I feel a purpose again; I am growing a child. I may not be training for a race or planning the next adventure (and part of that piece of me feels missing still), but at least I am able to create a human, something we've wanted for so long. I wish I could give you tangible steps to not attach your self worth to your productivity (and clearly that's where I was/am struggling), but I can't. I am still learning. But if you're going through infertility and or just need hope, I do have advice that helped me:

1. Find faith. My husband and I went to church every Sunday and prayed-cried-asked the Lord for a miracle for nine months. Without my faith, I'd have felt so alone, lost and without hope. Having a relationship with the Lord - and maybe it looks different for you than my Lord - truly provides you hope when you feel so alone. I can't imagine the state I'd been in if I didn't go to church and turn to God.

2. Find your perfect doctor. I am really passionate about this because I have had really shitty doctors. The perfect doctor exists, but it's on you to keep looking for the one that won't give up, has empathy, and wants to help you. It's not easy, but I was blessed to find the perfect OB, who connected me with a better endocrinolgist, and both have worked side by side to get me ready for pregnancy. I am so grateful to have not given up and settled for a doctor less invested in me.

3. Share with those who care. I shated my fertility issues with a select few who love me and listened. I am so grateful for those friends who spent so much time at my house listening to my struggles, staying by my side as i watched my body change on all the medication, and checked in when they knew I'd get either good or bad news. Being alone sounds fitting at the time; besides, it's a private matter, right? Wrong. Community and support is so important; and I am grateful for girlies that expressed so much love to me over this time.

   
   
   
   

My current diabetes management

Here's where the anxiety comes in! Now that I am pregnant, my management has to be so incredibly tight. Gone are the days of saying 140 is in range. I have adjusted my dexcom alerts to "high" when it goes over 140 and "low" if it is under 65. If I am crusing at 70... I don't treat it. If I am 115 with a sideways arrow up, I start bolusing. I have to literally be glued to my phone to make sure I am not trending one direction for too long. Truly, the battle of this is not meals... but the in between. I feel strongly about my current mealtime ratios. I eat less than 110 grams of carbohydrates a day, so this never really seems to be the issue. What's the issue is sitting for long periods of time, hormones in the early AM hours, stress, and walking when I have insulin on board. It's been tough. I am most absolutely going to have to stop training virtual clients earlier than I want to, simply because I am stuck in a seat while training them and if my bloodsugar rises, I can't just sit there and let it happen. Anyways, here is what i am currently doing to manage 75% in range for the first 10 weeks:

1. I have zero carbs before my morning workout but I don't do a fasted workout either. Instead, my go-to is hard boiled eggs and cream cheese. I bolus for about 5 grams for this becasue even some food and adrenaline in the AM will make my numbers go up, despite it being virtually carb free.

2. I am most naueous in the morning. I don't/can't have carbs becasue I'll plumit in my workout. Instead, I'll have 4-5 cashews (salted) first thing in the AM. I have also completely cut out caffiene simply because I can't stomach even the smell of coffee. It was rough for the first week of 4 am alarms, but it's gotten easier now. I drink way more water now that I am not drinking coffee too!

3. My workouts have plummited but I am still doing the damn thing. I normally run or walk for between 30-45 minutes, then I'll lift weights 4 times a week. During my cardio, my number does normally go up to 150. I don't do anything about it because the little amount my pump gives off with this being "high" brings it down. However, I now have to bolus one unit of insulin immediately after my cardio because I think my liver releases glucose during my strength sessions and I will go high if I don't.

4. Another change I've had to make and still learn is insulin after my long runs. I have been able to maintain a very slow 5-6 mile long run on Fridays. Although I am going SO slow, when I am done, my number normally spikes. Scientifically, this is due to my lack of carbohydrate intake in the morning; my liver dumps stored glycogen into my bloodstream post run (my body says, "hey, you need energy!") and causes a bloodsugar spike. I have been experimenting with how much insulin to give post-long run, but that's been a trial and error every week.

5. There are many times that dinner is mis-calculated due to me cooking for multiple (my husband and I) and estimating my carbohydrate intake based on two or three servings. Normally, this is fine; but since I am sensitive to even the slightest rise in bloodsugar, I sometimes have to go on a treadmill walk post-dinner to get my number from 160 to 120. This can sometimes lead to a low, if I'm not careful (due to insulin on board).

6. If my dinner is late at night (7:30 or later) I try to decrease my carb intake. This isn't easy because I noramlly want to just relax and have a normal meal by now! But my overnight blood sugars tend to run on the higher side so by eating less carbs at a late dinner, I have a better chance of controlling them overnight.

7. I frequently wake up at 12 am and 2 am to bolus. We haven't figured out why my insulin needs are so high overnight, but they are and it is quite annoying. I have my alarm set to go-off when it goes above 140, so I am normally woken up 2-3 times a night to give a bolus and help level it out. At week 13, I changed to manual mode on my omnipod overnight. This is helpful, but I do sometimes go low. I pretty much don't sleep at night lol!

   
   

   One thing that has been less than successful is achieving a fasting overnight bloodsugar of 90. I am hoping with more frequent MFM doctor appointments, that I'll be able to achieve this! But for now, I am satisfied when I can keep it under 140.

   
   

I hope this blog post provides you with some encouragment and hope. I am so incredibly grateful to not have had to make it as far as IVF. But to those trying and seeing lots of failed conception attempts; there is hope and science is powerful! I am sending you as much love and prayer that you may need to on your conception journey, with or without type one diabetes <3

I will be writing a First Trimester blog post, too!